up uninterruptedly for two years, unless symptoms of arsenical poisoning show themselves, when the course is temporarily intermitted. I have seen excellent results from this method of giving atoxyl, both alone and in combination with tartar emetic by mouth or intravenously.
Antimony in the form of sodium tartrate hypodermically has been shown by Plimmer and Thompson to cause, without the production of serious local irritation, almost immediate and often permanent disappearance of T. lewisi in infected rats. In two cases of trypanosomiasis in man in which I used this drug intramuscularly the consequent local pain and irritation (culminating in tissue necrosis) were so excessive that in this form the treatment had to be abandoned. One of the patients, however, continued the drug by mouth to the extent of 1½ to 2 gr. daily, very highly diluted, a little being given in all his food and drink, and along with atoxyl injections, for over two years. He appears to be quite well.
The value of antimony (tartar emetic) in the treatment of trypanosomiasis is so marked that, if possible, it should be employed in every case. It is far too irritating for intramuscular injection. It can be given, freely diluted in normal saline, per rectum; but the efficacy of this method of administration has not been proved. Though troublesome and not free from risk, the intravenous method is the best and the one now generally adopted. The dose is ½ gr., gradually increased to 1½ gr., in 6 oz. or thereabouts of sterile normal saline.
The solution must be slowly introduced, and great care taken that none of it escapes into the connective tissue surrounding the vein. Pain and swelling, and perhaps abscess, are apt to follow such an accident. With this in view it is well, before pouring the emetic solution into the receiver of the transfusing apparatus, to place in the latter an ounce or two of plain saline, and, when the emetic solution has nearly all run through, a similar quantity of saline.
Not infrequently during the progress of the trans-
